Ask the expert: Patients with borderline personalities

Nurse Leader Insider, October 10, 2011

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This week, Joan Lorenz, MSN, APRN, BC, discusses how to work with patients who have borderline personality disorders.

Q: We recently had a patient who suffered from Borderline Personality Disorder (BPD) and really caused some problems on my unit. Do you have any tips you can pass on?

A: You know you have a borderline personality on your unit if the nursing staff is in conflict over the patient's care. Some staff members want to rescue the patient, feel sorry for him or her, and over care for the patient. Others want to avoid the patient altogether.

Here are some ways to reduce the amount of havoc borderline patients can cause on a nursing unit:

  • Because they often are not able to distinguish between reality from their own misperceptions of the world and their surrounding environment due to their overwhelming emotions, it is important to be clear in all communications with them.
  • Because they often see others in black-and-white terms, they are prone to split the staff into two opposing teams. Thus, it is important for the entire team to get together behind closed doors and write a treatment plan that everyone agrees to follow.
  • Be on guard so as not to get sucked into a staff-splitting struggle. You need to be steadfast in following the treatment plan and not allow yourself to be seduced by the patient's behaviors and pleas.
  • Be aware that these patients are good at bringing out many negative feelings in others. Get support from the other staff members, ask for guidance from your supervisor, or request a consult from the mental health staff on how to better handle the situation with this patient.

- Joan Lorenz, MSN, APRN, BC

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